每日一题_2024.01.18

A 34-year-old woman with human immunodeficiency virus (HIV) infection presented with a 3-day history of a blind spot in her right eye. One week before the current presentation, the HIV viral load was 57 copies per milliliter (reference value, <20) and the CD4 cell count was 81 per cubic millimeter (reference range, 500 to 1500). On eye examination, visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundoscopy of the right eye revealed fulminant retinitis with dense areas of retinal necrosis and hemorrhage. The left eye, which had been asymptomatic, had similar changes. What is the diagnosis?

一名34岁女性，患有艾滋病病毒（HIV）感染，因右眼出现盲点3天前来就诊。在本次就诊前一周，HIV病毒载量为57拷贝/毫升（参考值：<20），CD4细胞计数为81个/立方毫米（参考范围：500至1500）。眼科检查显示，右眼视力为20/50，左眼视力为20/20。右眼眼底镜检查显示暴发性视网膜炎，伴有视网膜坏死和出血的密集区域。左眼虽然无症状，但也出现了类似的变化。诊断是什么？

A. Cytomegalovirus retinitis巨细胞病毒性视网膜炎

B. Herpes simplex retinitis单纯疱疹病毒性视网膜炎

C. HIV retinopathyHIV视网膜病变

D. Retinal vasculitis from ocular syphilis眼梅毒引起的视网膜血管炎

E. Toxoplasma retinitis弓形虫性视网膜炎

答案解析：

为了确诊病毒性视网膜炎，进行了前房穿刺术，并通过定量聚合酶链反应（PCR）检测发现巨细胞病毒（CMV）的病毒载量较高，从而确诊为CMV视网膜炎。CMV视网膜炎通常发生在严重免疫抑制的情况下，例如艾滋病（AIDS）患者中。在开始抗逆转录病毒治疗后，患者可能会在免疫重建期间出现疾病症状。

正确答案：A